Provider Demographics
NPI:1528274321
Name:KRISCHKE, J. MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:J.
Middle Name:MICHAEL
Last Name:KRISCHKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-663-2576
Mailing Address - Fax:219-663-3340
Practice Address - Street 1:700 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307
Practice Address - Country:US
Practice Address - Phone:219-663-2576
Practice Address - Fax:219-663-3340
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010801A1223G0001X
IL0190222711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice